Retiring early from medicine: Is it ethical?

Eight weeks after I delivered my third child, I was diagnosed with a four-centimeter lung mass. Yes, you heard that right. For those in medicine, this is terrifying to hear as the first thing that comes to mind is lung cancer. Lung cancer is notoriously hard to treat, typically fatal with a short life expectancy after diagnosis and extremely unfair to a lifelong nonsmoker who has spent 12 years in the prime of her life dedicated to training to become a physician.

Luckily, I soon found out my situation was not as grave as first expected. A PET scan leaned toward benign diagnosis (or at least consolidated disease). I could temporarily push aside the paralyzing fear of leaving my three young children with no mother and focus on getting rid of this mass that was causing pneumonia, difficulty breathing, coughing for more than two years and go ahead with scheduling the thoracotomy. After resection of the mass which was densely adherent to my pericardial sac and phrenic nerve, I lost about a third of my left lung. To my amazement, after my ICU stay I left breathing better than I had been in years. Benign diagnosis was confirmed.

This experience made me reevaluate my life, and it stopped my “hamster wheel” of life I had been running on at a dizzying speed. I viewed this health scare as a second chance at life. I didn’t take this lightly as it almost seemed unfair that I got this chance to live while others who have a lung mass often have it turn out to be one of the most fatal of cancers. Having to face the prospect of this potentially devastating diagnosis changed the course of my life. I was able to view my career for what it was and had become.

I had planned to work in my medical career as a physician indefinitely, or at least well into my 60s. It had always been my passion to work in obstetrics. I love my patients and the bonds I build with their families. It was never my intention to leave early, and it didn’t factor into choices along the way for my career. But here I was, ready to retire in my late 30s after several years of increasing disillusionment with the health care environment. Apparently, I just needed this wake-up call for a chance to realign my priorities.

Loss of physician autonomy, pressure to increase productivity as opposed to quality care and placing cost effectiveness ahead of best medical practice were weighing heavily on me. In addition, the litigious environment in the U.S. has become out of control and encourages frivolous lawsuits without any repercussions for those seeking damages without merit or basis for the claim.

I could no longer honestly tell myself that I was working so hard for the good of my patients, and I became cynical that my efforts were to the benefit of the financial bottom line of a health care system with its priorities out of sync with my own. This is not specific to any health care employer, physician group or hospital. It is emblematic of the U.S. health care system in general. It is the reason I left medicine entirely and did not seek to work elsewhere. The problem is pervasive.

The decision to leave became a question of: “Why am I doing this, and for whom?” I decided to retire early.

I have since learned that many feel this is not an appropriate thing to do in your late 30s. There is the argument that I owe a debt to society now that I have the skills acquired from all of those years of training. Or that the government paid for my residency salary and that I am indebted due to that. Or that it is selfish to stop working to spend more time with my family. There is the argument that it is not fair to leave my patients that I have been caring for over the years.

My response to the ethics of my decision to retire early: If you pay for the privilege of a medical degree and work hard to pay off this debt, should it be your decision if you want to continue to practice? The government did pay my salary as a resident, which amounted to a little more than minimum wage for four years of 80-hour work weeks. Do I owe something because of this?

As for leaving my patients, I actually do feel a little guilty about this one. I love my patients. I also struggle with no longer using my degree for clinical practice, something I worked so hard for. We are already feeling the strain of physician shortages and this another thing that gives me pause.

In the end, the burden of practicing medicine in today’s environment no longer outweighed the positives for me.

Ironically, it’s my patients who hugged me and told me how happy they were for me to live the life I felt I needed to. It’s my patients that spoke up (without me saying a word) about how the medical field has changed and that we are losing good doctors as the control of medicine is being handed to hospital administrators and politicians who are making choices about health care without a medical degree. It’s my patients that brought presents on my last days and thanked me for the care I did provide throughout my career instead of lament about what I “could” have done if I stayed longer.

It was a very personal and difficult decision for me to leave medicine and luckily, my colleagues who know me have been incredibly supportive. On the other hand, one thing that has surprised me is the number of physicians contacting me who want out of health care but don’t know how — or can’t — get out.

How do we retain physicians? It is not by increasing salaries. Doctors aren’t in it for the money; we chose this profession to help people and save lives. We do it by reforming the current health care environment and making this a profession that is sustainable.

Give medical decision making back to physicians. Decrease the cost of health care by cutting out costly administrators and through tort reform. This is the way to keep our best physicians and improve health care in our country for our patients.

Ultimately, is it ethical to retire early from a career in medicine? Or is it a bigger picture issue of how do physicians take back control of medicine so that we aren’t leaving at a time of shortage? This is a major concern for our country moving forward.

Valerie A. Jones is a obstetrician-gynecologist who blogs at OB Doctor Mom.